The governance of tertiary care presents unique complexities that distinguish them from other healthcare levels. This complexity is particularly pronounced when tertiary care providers are integrated with academic functions, creating what is often referred to as the "triple mission": service delivery, medical education, and research.
One of the fundamental challenges in tertiary care governance is the difficulty in defining tertiary care services in ways that can be tied to stable payment mechanisms. Unlike primary care visits or standard surgical procedures, tertiary care often involves complex, multi-faceted interventions that may span multiple specialties and require varying levels of resource intensity. This definitional challenge is compounded by the rapid pace of technological developments, making it difficult for payment mechanisms to keep pace with innovation.
This paper reviews key features of the governance of tertiary care in five OECD countries – Austria, Czechia, France, Germany and the Netherlands – to promote policy discussions about best practice in the regulation and financing of tertiary care across OECD, with a focus on Slovenia.
